State Laws and Regulations Specific to Dialysis: An Overview
[Pages:7]State Laws and Regulations Specific to Dialysis: An Overview
Cathleen O'Keefe
T he renal community has long had need for a thorough compilation of information on laws and regulations specific to dialysis on a state by state basis to guide the clinical practice of dialysis and for compliance purposes. In recognition of that need, Fresenius Medical Care
North America (FMCNA) undertook the process of gathering such information. The final product has been offered to the community through the American Nephrology Nurses' Association since much of the information relates to the scope of practice and delegation authority of registered
nurses and the licensed practical/vocational nurses and unlicensed dialysis technicians they supervise. FMCNA has made a commitment to update this information on a regular basis for publication annually. ANNA is grateful to Fresenius for this contribution to the industry.
State ALABAMA
PCTs Allowed to Administer Heparin and
Saline
Delegation Authority of RNs/ Limitations on LPN/LVNs or UAP
NO
Tasks that may not be delegated to UAP
include administration of medications. Limits
on IV therapy by LPN - no direct IV bolus
meds.
abn.state.al.us/welcome.html
Dialysis Technician Legislation
NO
Dialysis Facility Legislation
CON and Licensure
ALASKA
NO
Nursing tasks that shall not be delegated from
NO
RNs to LPNs include "Administer IV push
medications ? RNs Only."
dced.state.ak.us/occ/pub/Nursing
Statutes.pdf
ARKANSAS
NO
Nursing tasks that shall not be delegated...
NO
"Administration of any medications or IV thera-
py, including blood or blood products."
ARIZONA CALIFORNIA
YES YES
Dialysis technician certification through a national organization (NANT) or have completion of minimum training requirements. azleg.state.az.us/legtext/45leg/2r/ summary/h.hb2359_2-08-02_health.doc.htm Experienced hemodialysis technician trainees may administer local anesthetic, anticoagulants, or replacement saline. public_services/Title_09/ 9-10.rtf.
Cannulation, administration of local anesthetics, heparin, and sodium chloride solutions allowed for technicians. Certification required. 1247%2D1247.9.html LPNs may not access central line catheters.
YES Included with facility licensure
law
YES
Licensure Licensure
Cathleen O'Keefe, JD, RN, is Executive Director, Regulatory, Government Affairs, and Compliance, Spectra, Laboratory Division of Fresenius at Fresenius Medical Care North America, Lexington, MA.
Acknowledgement: The author would like to thank Kasia Januszewski Bartos, Esq., and Mary B. Snyder, MA, JD, Regulatory Affairs Manager, both of Fresenius Medical Care North America, for conducting much of the initial state-by-state research on which this final document is based.
Disclaimer: The information contained in the document is limited to the information published on Board of Nursing (BoN) websites, BoN advisory opinions, and the accessibility of other communications, rules and regulations. It is intended as a general reference tool to facilitate state-specific research, is current only through December 2004, does not constitute legal advice, and should not be used as a substitute for review of the actual statutes and regulations governing scope of practice in any jurisdiction.
Note: Copyright 2005, Fresenius Medical Care North America. Published with permission in Nephrology Nursing Journal, Volume 32, Number 1, pages 31-37.
NEPHROLOGY NURSING JOURNAL January-February 2005 Vol. 32, No. 1
31
State Laws and Regulations Specific to Dialysis: An Overview
State COLORADO
PCTs Allowed to Administer Heparin and
Saline
Delegation Authority of RNs/ Limitations on LPN/LVNs or UAP
No Express Prohibition
Broad delegation language. statutesandrules/npa.htm
CONNECTICUT
NO
Staffing requirements include 50% licensed
nurses. PCTs may initiate, monitor, and
terminate dialysis treatments.
dph.state.ct.us/phc/phc.asp
DELAWARE
NO
Delegation by RNs only. RNs may not dele-
gate administration of meds to UAP.
professionallicensing.state.de.us/
boards/nursing/renewal.shtml
DISTRICT of COLUMBIA
No Express Prohibition
Scope of Practice for LPNs includes administering medication. dchealth.prof_license/services/p dffile/PDF_frameset.asp?id=Nursing/Munici palNursingRegulations.pdf&strAppId=11
FLORIDA
No Heparin Yes Saline
No RN delegation language. Statutes/index.cfm Agency for Healthcare Administration position statement prohibits heparin administration.
GEORGIA
No Heparin Yes Saline
Requires training program for hemodialysis PCTs. National certification exam not required. LPNs required to meet the same training and competency requirements as PCTs. ORS/esrdrules.htm#290-9-9-.11
HAWAII
No Express Prohibition
No delegation of IV meds unless criteria for delegation is met." Delegation criteria... " the delegating RN shall teach UAP special tasks of nursing care and verify the UAP's competency to perform the tasks." dcca/pdf/hrs_pvl_457.pdf
IDAHO
NO
May not delegate to UAPs preparation or
administration of injections, or start, stop, or
adjust any IV therapy.
es/idapa23/0101.pdf
ILLINOIS
NO
Delegation: The transfer of responsibility for
the performance of selected tasks by the reg-
istered nurse (RN) to qualified, competent
assistive personnel in a selected situation,
based upon the RN's plan of care.
WHO/nurs.asp
Dialysis Technician Legislation
NO YES NO NO NO
NO
NO NO
Dialysis Facility Legislation Licensure Licensure
CON
Licensure
CON
NO Licensure law passed; no rules promulgated
32
NEPHROLOGY NURSING JOURNAL January-February 2005 Vol. 32, No. 1
State INDIANA
IOWA
KANSAS KENTUCKY LOUISIANA MAINE
MARYLAND
PCTs Allowed to Administer Heparin and
Saline
Delegation Authority of RNs/ Limitations on LPN/LVNs or UAP
No Express Probibition
RNs can delegate if task does not exceed the scope of practice of delegatee. Nurses must balance with ethical duty where there can be no delegation if the nurse knows/should know it is detrimental to patient's health. state.in.us/hpb/boards/isbn/nursing_ compilation.pdf
No Express Prohibition
In a dialysis unit, RN may delegate heparin and saline administration to an LPN. RN cannot delegate to UAP anything beyond the scope of practice of LPN. legis.state.ia.us/Rules/2003/iac/655/65 56/6556.pdf
YES
All nursing procedures, including, but not limited to, the administration of medication, delegated by a licensed nurse to a designated unlicensed person shall be supervised. npatoc.htm
YES
Dialysis Tech Credentialing. PCTs may cannulate,and administer heparin (specified doses), normal saline, intradermal lidocaine. kbn.practice.htm
No IV Push
Advisory Opinion allows LPN administration of IV heparin for hemodialysis. pe/rnscope.pdf
No Express Prohibition
Rules mention UAPs and CNAs. Nothing specific on dialysis PCTs. Certified Nursing Assistants may administer meds, but only if a med course is taken, certain meds only, and no IV meds. e32ch31sec0.html
YES
Dialysis technicians are listed as a specific category of certified nursing assistant, CNA DT. Approved training program is required; two year renewal period.
Dialysis Technician Legislation
YES
Dialysis Facility Legislation
Licensure Licensure
CON Licensure
NEPHROLOGY NURSING JOURNAL January-February 2005 Vol. 32, No. 1
33
State Laws and Regulations Specific to Dialysis: An Overview
State MASSACHUSETTS
MICHIGAN MINNESOTA
MISSISSIPPI
MISSOURI MONTANA NEBRASKA NEVADA
PCTs Allowed to Administer Heparin and
Saline
Delegation Authority of RNs/ Limitations on LPN/LVNs or UAP
YES
Delegation to Unlicensed Personnel. Nursing advisory ruling. dpl/boards/rn/cmr/24403.htm#3.05 Mass Nurses Organization Position Statement. Statements/Unlicensed%20Assistive%20Per sonnel.htm
No Express Prohibition
Broad delegation language. sp?AdminCode=Single&Admin_Num=3381 0101& Dpt=CH&RngHigh=
No Express Prohibition
In a nursing home setting, medications by injection can be given only by physician, physician's assistant, RN, LPN. Nothing on dialysis. /content.do?rc_layout=bottom&subchannel=null&programid=536898085&sc3=null& sc2=null&id= 536882405&agency=NursingBoard
NO
Administration of meds can be delegated only
to licensed nurses, either an RN or LPN.
Nursing rules allow LPNs to cannulate and
administer IV heparin or IV saline. Technicians
may not cannulate.
No Express Prohibition
LPNs allowed to administer IV heparin. No specific language regarding delegating to dialysis technicians.
No Express Prohibition
Nurses cannot delegate administration of medications. d/license/bsd_boards/nur_board/pdf/practice_statements.pdf
YES
Specific hemodialysis functions allowed for LPNs and PCTs include cannulation and administration of heparin and saline. 2Dlpn/advisory.htm#DELEGATION
YES
A drug or medicine referred to in NRS 454.181 to 454.371, inclusive, may be possessed and administered by: " A dialysis technician, under the direction or supervision of a physician or registered nurse only if the drug or medicine is used for the process of renal dialysis."
Dialysis Technician Legislation
YES
Dialysis Facility Legislation Licensure
CON
CON Dialysis technician language in pro-
posed delagtion rules as of 1/05.
Licensure
34
NEPHROLOGY NURSING JOURNAL January-February 2005 Vol. 32, No. 1
State
NEW HAMPSHIRE
PCTs Allowed to Administer Heparin and
Saline
Delegation Authority of RNs/ Limitations on LPN/LVNs or UAP
YES
RNs only can delegate IV administration of meds. Delegation of a task of client care involving the administration of medication shall specify the med, dosage, route. Pharmacy rules allow PCTs to administer saline and heparin.
NEW JERSEY
No Express Prohibition
An RN may delegate selected nursing tasks to the LPN and ancillary nursing personnel (including aids, assistants, attendants and technicians). Nothing specific as to administration of medications or dialysis technicians. aws.pdf
NEW MEXICO
YES
Hemodialysis Technician can cannulate and administer heparin bolus. Training and testing required for certified hemodialysis technicians. nmacpart4.pdf
NEW YORK
NO
Properly trained dialysis technicians are
allowed to flush IV lines with pre-determined
doses of heparin when initiating dialysis.
rts/alert5.htm
Limitations on LPNs administering IV meds.
No IV push except saline or heparin.
longterm.htm
NORTH CAROLINA
NO
The dialysis technician may administer
heparin, lidocaine, and normal saline.
Cannulation may be done by licensed nurse or
competent dialysis technician.
NORTH DAKOTA
YES
Delegation rules for UAPs do not allow IV meds. medication_admin.html
OHIO
NO
Delegation - Dialysis Technicians can adminis-
ter IV heparin. Tech rules require certification.
Rules/CHAPT-23.pdf
Dialysis Technician Legislation
YES YES
YES
YES
Dialysis Facility Legislation Licensure
Licensure
Licensure CON
Licensure
CON
CON
NEPHROLOGY NURSING JOURNAL January-February 2005 Vol. 32, No. 1
35
State Laws and Regulations Specific to Dialysis: An Overview
State OKLAHOMA
PCTs Allowed to Administer Heparin and
Saline
Delegation Authority of RNs/ Limitations on LPN/LVNs or UAP
NO
Administration of meds may not be delegated.
nursing/delegation.pdf
BONPosition Paper on LPN administration of IV
meds, May 2002... "IV therapy and medication
administration may be within the scope of practice
of LPN who has appropriate educational training
and under supervision."
OREGON
YES
Effective August 2001. Requires certification by a nationally standardized exam _300/OAR_333/333_275.html
PENNSYLVANIA
YES
? 18.402. Delegation A medical doctor may delegate to a health care practitioner or technician the performance of a medical service if certain conditions are met. secure/data/049/chapter18/ subchapGtoc.html LPNs can administer IV meds after completing an approved course. dos.state.pa.us/bpoa/lib/bpoa/20/ nurs_board/nurseact.pdf
RHODE ISLAND
No Express Prohibition
Broad delgation language. State approved broad delegation course for nursing students , no controlled substances allowed. proposed/nursing_prop.pdf
SOUTH CAROLINA
NO
After June 30, 1985, unlicensed nursing personnel
shall not administer medications. BON - the regu-
lations preclude the licensed nurse from delegating
administration of medications to UAP.
?file=uaptasks.htm
LPNs may administer IV saline /heparin push.
llr.state.sc.us/pol/nursing/index.asp?file=
advisoryop10b.htm
SOUTH DAKOTA
YES
LPNs may cannulate and administer IV saline and heparin. : 48:04:01 Dialysis techs may administer loading and maintenance doses of heparin according to prescribed protocol. : 48:04:02
TENNESSEE
NO
LNPs may administer IV meds in ESRD
settings- BON Position Statement.
4009.pdf
BON will not approve a program for UAPs to
administer meds. 12/01
1186.pdf
Dialysis Technician Legislation
YES YES NO
Dialysis Facility Legislation Proposed
Licensure Law Licensure
Licensure Licensure
Licensure
36
NEPHROLOGY NURSING JOURNAL January-February 2005 Vol. 32, No. 1
State TEXAS
PCTs Allowed to Administer Heparin and
Saline
Delegation Authority of RNs/ Limitations on LPN/LVNs or UAP
YES
Licensure law/regs allow cannulation, administration of heparin, saline, and lidocaine. Requires training for dialysis technicians, certification by a nationally standardized examination may be substituted.
UTAH
No Express Prohibition
Broad delegation language from RN to UAP. nd_rules/R156-31b.PDF
VERMONT
No Express Prohibition
LPNs allowed to perform IV therapy. Nothing specific to dialysis technicians. nursingopinions.pdf
VIRGINIA
YES
PCTs may administer heparin, saline PCT training program. dhp.state.va.us/bhp/leg/Dialysis%20regs.doc
WASHINGTON
YES
July 2001 - Dialysis regulations requires standardized training of technicians. LPNs may administer IV push if protocols in place Nursing/documents/LPN-ivtherapy.pdf A health care assistant trained by a federallyapproved ESRD facility may perform venipuncture for blood withdrawal, venipuncture for placement of fistula needles, IV administration of heparin and saline as an integral part of dialysis treatment leg.sl/2001-02/1309_sl.txt leg.RCW/index.cfm?setion=18.135.060&fuseaction=section
WEST VIRGINIA
NO
Additional limitations on medication administra-
tion by facility staff members include injections or
parenteral medications. No delegation authority
for techs to administer saline or heparin; recent
law passed, requires subsequent legislation.
WISCONSIN
No Express Prohibition
LPNs may administer IV medications with supervision if competent. Delegation language is very broad.
WYOMING
No Express Prohibition
Broad delegation language. Regulations defining the role of certified nursing assistants. No dialysis technician language.
Dialysis Technician Legislation
Dialysis Facility Legislation Licensure
CON
CON
NEPHROLOGY NURSING JOURNAL January-February 2005 Vol. 32, No. 1
37
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